THE
4 ustrah'an Medical Yournal
JANUARY 15, 1891.
J_1 Socitty Victoria.
ADJOURNED MONTHLY MEETING.
TUESDAY, DECEMBER 16, 1 8 9 O.
(Hall of the Society, 8 p.m.)
The President, Dr. JACKSON, occupied the chair, and there was a small attendance of members.
Nominations of office-bearers for 1891 were received.
The following paper was then read :-
A CASE OF EMPHYSEMA, FOLLOWING SOME RUPTURE OF THE EUSTACHIAN TUBE.
By AUGUSTUS LEO KENNY, M.B., B.S.
J. II. B., aet. 32, married, Civil Engineer, residing in an adjoining colony, came to consult me on July 18, 1890. He complained of deafness of the left ear, which he had noticed for eighteen months. Previous history good, with the exception that he had had fever and ague, and had taken a quantity of quinine by way of treatment; lived in the open air, and took vigorous athletic exercise, such as rowing.
With his right ear he could hear my watch at fifteen inches (it is ordinarily heard at five feet) ; with the left he could not hear it when placed in firm contact with the auricle. Ordinary conver- sation was heard with the right ear ; one had almost to shout in order to be heard in the left.
The diapason (tuning fork), when placed on the vertex of his skull, was heard equally in both ears, and no change was perceived by the patient on blocking each ear alternately.
On testing by Rinne's method, i.e., comparing the length of time during which the sound of the fork is heard when held close to the ear (aerial conduction), with that during which the sound is heard with the handle of the fork firmly pressed to the mastoid (bone conduction), it was found that bone conduction was very good, whilst aerial conduction was defective, though more defective in the right (fifteen seconds), than in the left ear (two minutes).
By Gardiner Brown's method, i.e., placing the handle of the fork (vibrating) on the root of the nose, and holding it firmly
VOL• XIII. No. 1. A
2 Australian Medical Journal. JAN. 15, 1891
there until the patient declares that the sound has ceased, then observing for what space of time you can feel the vibrations through the handle after the patient ceases to hear the sound, the hearing was perfect, no vibrations being perceptible after the patient failed to hear the sound.
These tests showed that the deafness was not due to disease of the auditory nerve, but to disease of, or defect in, the conducting apparatus.
On inspection, the right meatus was found plugged with cerumen.
After this had been removed by syringing, the membrana tympani was seen to be somewhat opaque, the triangular shining spot clearly defined. The membrane moved freely with the use of Siegle's pneumatic speculum. The left membrane was slightly. opaque, indrawn (not strongly), and pale. The triangular spot was well seen, and the movements were fairly good with Siegle's speculum.
Inspection of the nose anteriorly showed congested swelling of the right inferior turbinated body, and two spurs growing from the cartilaginous portion of the left side of the septum, about the level of the inferior turbinated body. The pharynx showed large granu- lations on the posterior wall.
By posterior rhinoscopy, the middle and lower turbinated bodies on both sides were considerably hypertrophied, as also the superior on the left side ; they presented a polypoid appearance. The enlargements of the inferior turbinated bones caused considerable difficulty in the manipulation of the Eustachian catheter, so much so that it could not be passed into the left tubal orifice through the left nostril. The left tube and tympanum had to be inflated per catheter passed through the right nostril. The right tube was found to be free, but the left was constricted, and gave faint moist roles and gurgling sounds. The hearing was not improved by the inflation.
With the galvan-o-cautery, I freely cauterised the enlarged posterior ends of the inferior turbinated bodies from the front, and also burned several of the larger granules in the pharynx.
After three days, the use of the catheter was resumed, both tubes being inflated through the right nostril. Fine bougies were passed into the left tube per catheter, twice weekly. These were tightly gripped, but after their use inflation was performed more satisfactorily.
On July 31, 1890, a catgut bougie was passed into the left tube as usual. At the end of consultation, patient made attempts
JAL 15, 1891 A Case of Emphysema. 3 to inflate his tubes, according to Valsalva's method, using a great amount of force, and causing marked congestion of the head.
About eight hours later I was called to see him. I found him semi-collapsed, with a grave sense of impending danger, dyspncea, intense constricting girdle-pain in the chest, about the level of the nipples, and a tendency to syncope. He and his wife told me that shortly after leaving my surgery a swelling suddenly appeared in the left side of the neck, below the ear, and behind the ramus of the lower jaw—this had increased both upwards and down- wards, and his present symptoms had come on gradually—had been more severe, but were now abating. Whilst examining, patient had an attack of syncope, which yielded to inhalation of nitrite of amyl (three minim capsule). Marked crepitation on palpation was observed, extending from some distance above the left ear down along the front edge of the sterno-mastoid, under- neath the lower jaw and the floor of the mouth, reaching as high as the right ear, extending across the front of the neck to the right s
terno-mastoid, thence to the sternum, being there lost in the chest. It was thought some crepitation could be felt below the ensiform cartilage, but this was doubtful. There was, clearly, extensive emphysema of the subcutaneous cellular tissue, origina- ting in the neighbourhood of the left Eustachian tube, and 'extending into the inediastinum, mechanically interfering with respiration, and the heart's action. On examination, no laceration or rupture in the nose or nasopharynx could be detected, the point of entry of the air was evidently in the Eustachian tube, through a tear caused by the bougie, and enlarged by the patient's efforts, or possibly caused by those efforts.
The patient was relieved by taking cardiac and respiratory stimulants, hot fomentations to the neck, boro-glyceride as a gargle and nasal douche. The emphysema gradually disappeared, though slight crepitation could be felt for some three or four days under the chin.
These cases are interesting because of their comparative rarity.
I have never seen another such case, and very brief mention is made of them in the text-books. Hartmann, of Berlin, in his book on the Ear states that " alarming and even dangerous accidents may be caused by the catheter injuring the mucous membrane, and inflating the subjacent and surrounding tissues with air. This happens most frequently after passing bougies into the Eustachian tube. The emphysema produced in this manner extends to the
A 2
4 Australian Medical Journal. JAN. 15, 1891
lateral wall of the pharynx, the soft palate, the uvula, and even to the glottis, sometimes extending also externally down the neck, even to the chest. Its symptoms are a feeling as of a foreign body in the throat, pain, difficulty in swallowing, and, in very severe cases, a choking sensation." I was not able to examine the patient's larynx ; probably there was oedema of the glottis ; there was no oedema of the pharynx.
An element of anxiety existed on account of the possibility of the air in the cellular tissue becoming septic, as a result of the previous cauterisation of the turbinated bones. On several occasions since then I have bougied the tube, and inflated the tympanum, but have failed to detect any false passage.
Dr. BARRETT said that Dr. Kenny had done good service in bringing forward such a case, on account of its great rarity. It brought up the question of the relative advisability of inflation by means of the Eustachian catheter, and by other methods. It was urged that by Valsalva's method, the ossicles might be dislocated, and the membrane thus rendered lax. He thought little of the objection, and was in the habit of using this method, but it should not be done violently.
Dr. HOOPER mentioned that he had seen two cases of emphysema of the neck, coming on in the expulsive stage of labour in strong healthy women.
Dr. KENNY, in reply, said that although many authorities condemned auto-inflation, he believed in it if done mildly. The advantage of the catheter was, that you could inflate one ear only.
The following papers were then read :-
A CASE OF SYNCOPE DURING CHLOROFORM ADMINISTRATION.
By JAMES W. BARRETT, M.D.
A young man, pale and nervous, submitted to an operation for strabismus at the Victorian Eye and Ear Hospital. Dr. Gray operated, dividing both internal recti. There was no evidence of heart disease. There were present in the room, besides Dr. Gray and myself, Dr. Palmer of Ararat, and Dr. Gutheil, the house surgeon.
For some time past I have noticed that during this operation the heart-beat is often slowed, and sometimes stopped during the
JAL 15, 1891 Respiratory Failure during Chloroform Adminis. 5 hooking forward of the tendon, consequently I was more than
"usually alert. I gave chloroform slowly and carefully until the conjunctivae were insensitive ; Dr. Gray then introduced the speculum into the right eye, when slight reflex squeezing of the lids took place. He proceeded with the operation, whilst I kept my finger on the pulse. Whilst he pulled forward and divided the tendon, the heart stopped for a period of certainly more than two beats—I judged it three or four beats. The face slightly blanched, but the breathing was not .affected. I drew the atten- tion of those present to the stoppage, and Dr. Palmer noted the pallor. The patient remaining under the antesthetic, breathing well, and heart beating normally, Dr. Gray introduced the speculum into the left eye, when, if I remember rightly, slight reflex contraction of the lids again occurred. Dr. Gray was dividing the tendon, when the heart and the breathing stopped, the face blanched, and all the appearances of fatal syncope were manifested. The head was immediately over-extended and lowered, nitrite of amyl inhaled, and forcible artificial respiration resorted to. Shortly the breathing and the heart action were resumed. The patient remained profoundly unconscious for some minutes (all ordinary reflex action being abolished), and did not perfectly recover for twenty-four hours, that is to say on the following day he still manifested tendency to syncope when attending at the hospital.
In the light of recent events, I desire to place this case on record to show—(1) that whatever was the cause, the heart stopped before the respiration ; (2) that the division of the rectus was the exciting cause of the heart failure ; (3) that chloroform had been given to such an extent as to abolish the conjunctival reflex to speculum, the finger, but not to abolish some reflex to the
I know of no cases in which I regard chloroform more danger- ous than in the case of young, nervous, debilitated adults, during the squint operation.
A CASE OF RESPIRATORY FAILURE DURING CHLOROFORM ADMINISTRATION.
By JAMES W. BARRETT, M.D.
A boy, aged 7, was affected with a tumour of the larynx (papilloma), which grew over the rima glottis, caused dyspncea, and for which I performed tracheotomy. Some months later,
6 Australian Medical Journal. JAN. 15, 1€19$
I endeavoured to remove the tumour. Three methods were open to me—(1) The endo-laryngeal method, with chloroform.
(2) The endo-laryngeal method, without chloroform. (3) The method of laryngo-fissure. The parents ruled (3) out of court, and I essayed
(1).
In the first instance, I determined to introduce the Mackenzie antero-posterior forceps in the midline, and seize the tumour. Dr. A. S. Aitchison gave chloroform for me.A mask was applied over the tracheotomy tube (for reasons.
that need not here be. detailed), and a small quantity of chloroform was applied. After a few inspirations, the boy became unconcious, stopped breathing, and became livid, the heart continuing to beat vigorously. After a few anxious minutes of artificial respira- tion, he recovered, and shortly after came nearly out of the influence of the chloroform. Determined to make an attempt
to
remove the tumour, I introduced my finger into the pharynx, and examined the upper aperture of the larynx, when immediately laryngeal and thoracic expiratory spasms were induced. There was nothing novel in this, so I continued the examination till compelled to desist by the alarming lividity. Again some resort to artificial respiration was wanted. After waiting a time, a like•attempt was followed by a similar result, and the operation was abandoned.
This case I take to be one in which a small quantity of chloroform introduced directly into the lungs, caused the failure of an abnormal respiratory centre. This abnormality was shown by the fact, that a moderate stimulus of the superior laryngeal nerve was more powerful to cause expiratory spasm, than the circulation of de-oxygenated blood through the medulla to cause inspiration.
Dr. G. HORNE mentioned two cases within the last three weeks in which he had seen troublesome symptoms arise during chloro- form administration. In the first case he was administering the chloroform, whilst Dr. Cole performed circumcision, the patient being a very nervous young man. He became quite faint, and then his breathing stopped. Nitrite of amyl was used without benefit ; but after artificial respiration had been used for a few minutes, the patient came round. The other case was that of a nervous girl, to whom chloroform was administered for curetting the uterus. Her pulse stopped first, then the breathing. Nitrite•
of amyl was again no good ; but the patient recovered when artificial respiration was performed.
Jell. 15, 1891 Respiratory Failure during Chloroform Adminis.
Dr. BARRETT, in reply, said that he now thought that ether would have been better for the first case, and he was now giving ether to all such patients in whom the muscular system is generally deficient, and in whom the cardiac muscle is not up to the normal. He only brought forward the second case as showing that the inspiratory centre was very insensible to stimuli.
Oita' xycittp of Victoria.
ORDINARY MONTHLY MEETING.
WEDNESDAY, JANUARY 7TH, 1891.
(Hall of the Society, 8 p.m.)
Dr. JACKSON, President, in the chair. There was a large attendanc e of members.
The minutes of the meeting, December 10, 1890, and the adjourned meeting, December 16, 1890, were read and confirmed.
A letter from the Hon. Sec. of the Queensland Medico-Ethical Association was read, and on the motion of Dr. Neild, seconded by Dr. Le Fevre, was referred to the Committee.
The HON. SECRETARY made a report with reference to the plebiscite, taken to ascertain the opinion of the members regarding the formation of sections. The time for returning these papers was extended for one month.
Dr. George Shirres, M.D., D.P.H. Aberdeen, of the Board of Public Health, was elected a member of the Society.
CORRESPONDENCE.
A letter from the Hon. Secretary of the Victorian Branch of the British Medical Association, with reference to the proposals for am
algamation, was read. It stated, that at a Special General Meeting of the Members of the Branch, the following resolution was carried :—" That the Hon. Secretary be requested to write to the Medical Society of Victoria, asking its members to agree to some such basis of amalgamation as those mentioned in the enclosed circular, subject to another meeting of the members of the Branch notifying them, and the home authorities agreeing to them."
The following are the proposals referred to :-
(1) The Victorian Medical Society, to be called in future, the Victorian Medical Society (with which is
8 Australian Medical Journal. JAN. 15, 1891
incorporated the Victorian Branch of the British Medical Association).
(2) All Members of the British Medical Association (Victorian Branch) to become Members of the Victorian Medical Society (without election).
(3) An Assistant Secretary to be appointed to undertake (a) the distribution of the British Medical Journal, and (b) any other British Medical Association work that may be required.
(4) Members of the Victorian Medical Society to take the British Medical Journal or not, just as they wish ; if they take it, they will pay about 1 ls. per annum for it.
Dr. BARRETT explained that the action referred to in the proposals had been taken because the Committee had been informed that there was a very general desire on the part of members of the Branch to amalgamate the two Societies, and had thought it well, accordingly, to take the initiative. Clause 4 was to be improved. There was a project to continue the Victorian Branch of the British Medical Association as a section of the Society, no one to be a member without first becoming a member of the Society.
Dr. BRETT asked the President or Secretary of the Branch, whether they had taken any steps to ascertain the legality of the step proposed to be taken. From experience of the Madras Branch, he thought the Council at home would not consent.
We would have to give up being members of the Victorian Branch, and become unattached members of the British Medical . Medical Association.
Dr. LE FEVRE, as President of the Victorian Branch of the British Medical Association, said that for the last two years he had felt that there was a great waste of time and energy in the separate meetings of the two bodies. For part of the year there had been bare quorums at the meetings of the Branch, difficulty in the proper supply of papers, practically the same members attending both meetings, the members of the Committee of one and the Council of the other were almost identical. The Victorian Branch were indebted to the Society for the use of the hall.
Although very good progress had been made, and the number of members in eight or nine years of growth had reached 160, yet
JAN. 15, 1891 Medical Society of Victoria. 9
many thought the Branch was not occupying the position it should. There were only sixty members of the Branch not members of the Medical Society, and it would be better that the brains, energy and money of the two Societies should be concen- trated. It was only the Presidents and Secretaries of the two bodies who could accurately judge of the hard work required to keep the two bodies going. Amalgamation would be of material help to the Medical Association financially, and in the good quality of the work done. On the authority of Dr. Henry, who had been instrumental in the formation of the Branch, he believed that the proposal would meet with the approval of the Home Association, even on the present basis. Dr. Henry had forwarded to the Council of the Association a statement of the whole scheme, and had recommended their acceptance of it. The motion carried at the Special Meeting still leaves the matter open to the Home Association and the Branch. The voting was almost unanimous in re
commending the course indicated in the Honorary Secre- tary's letter ; there were two votes against, but he believed that they were given under misapprehension, and that such misappre- hension would be removed at the next meeting of the Branch.
Dr. J. P. RYAN proposed, "That the action of the Committee in its efforts to amalgamate the two Societies be endorsed by the Medical Society." It was not necessary to refer to the unhappy incidents which caused the foundation of the Victorian Branch of the British Medical Association—that was due to misappre- hension, which, under other conditions, might have operated differently. -Unfortunately, there were troubles amongst the members at the time regarding admissions, &c., and this helped the secession. The profession in the Colony was not numerous enough for two Societies. He trusted that the good sense of the the wishing conciliation would meet with success.; that h e two Societies would join hands and work harmoniously as formerly.
Dr. B
ALLS-IlEADLEv seconded the motion. Medical men should be united. It was important legally, and the Colony was too small for two. independent Societies.
Dr. NEILD had no disposition to oppose the motion, but wished to
Dr. correct possible misapprehension of the remarks made by J. P. Ryan. There had been in no sense a secession in the formation of the Victorian Branch of the British Medical Association. Dr. Henry and himself had instituted the Branch
10 Australian Medical Journal. Jew. 15, 1891 because there had been a long expressed desire for it, on the grounds that it would be advantageous to be connected with such a great organisation, and because the British Medical Journal could be the more easily obtained. Whatever differences might have existed in the Medical Society, the foundation of the Branch was merely coincident—those who met to form it, with one exception, were members of the Society—none seceded. Two or three years later there was a desire to associate with the Medical Society, but the proposal made by the Branch was not favorably received. Since then the Branch had gone on well and fairly.
There was no antagonism, and no opposition. He was glad than the overtures in the present instance came from the Society. He was not aware that anything had been said in the Branch, desiring to amalgamate, for some time—the urgency for such a step had not made itself apparent—hence this movement took him by surprise. He was indisposed to support an amalgamation involving the sinking of the individuality of the Branch.
Inasmuch as the Branch was part of a very large Association, he did not think it fair that the Branch should be told that it was in its own interest that it should be fused in the Medical Society.
The Branch was going on fairly and satisfactorily, and there was nothing obligatory to make it fuse. He did not see that fusion, admitting that it was highly desirable on both sides, was easy.
There were many difficulties. The rules of the two Societies provide for distinctly different forms of government and of organisation. He would express his approval of the idea of amalgamation, but would refer the details to some special meeting of the Committee of the Medical Society with the Council of the Victorian Branch of the British Medical Association.
Dr. J. P. RYAN was clad to be corrected by Dr. Neild as to the origin of the Victorian Branch of the British Medical Association, and to and that the feeling which he feared existed did not exist, and never had existed.
Dr. NEILD said that if the motion were carried, the matter should be referred to the Committee of the Society and the Council of the Association, whose report should be referred to a general meeting of the two Societies.
Dr. GRANT spoke in support of Dr. Neild's suggestion.
Dr. KENNY said that the matter, as it came from the British Medical Association, did not bind them to anything, nor was Dr.
Ryan's motion binding. It seemed that the proper course would it
JAR. 15, 1891 Annual Report.
be to carry Dr. Ryan's motion, then Dr. Neild's proposal could be considered.
Dr. Ryan's motion was then put to the meeting, and carried nem. con.
Dr. NEILD then moved, and Dr. GRANT seconded, a resolution to the effect that the matter be referred to the Committees of the two Societies, which was carried.
The SECRETARY then read the Report of the Committee for the year 1890 as follows :—
REPORT OF COMMITTEE FOR 1890.
The Committee have again to congratulate the members on the steady progress made by the Society in all directions, and look back with satisfaction on a prosperous year.
The Society now numbers 22 life members, 192 ordinary members, 15 corresponding members, 12 honorary members- 241 in all.
During the year 17 new ordinary members have been elected, two ordinary members have become life members, three more corresponding members, and one an honorary member.
Death has removed three names from the roll, non-payment of subscription has been the cause of the erasure of another name, and three have resigned.
When it is remembered that during 1890 the subscription was raised to £2 2s., the condition of affairs indicated may be regarded as thoroughly sound. The Society is thus in receipt of an incom e of over £400 per annum, and the increase of the subscription and issue of the Journal to members has proved to be a wise change.
th There have been 11 meetings (and one adjourned meeting) for e transaction of scientific business, at which the average attendance has been 18.
At these meetings, the following business has been transacted..
Papers have been read on the following subjects :
" Punctured Fracture of the Skull," by Mr. Girdlestone.
" Uterine Fibroids," by Dr. Carnegie McMullen.
Intussuseeption," by Dr. G. S. Ryan.
" Some Skin Diseases," by Dr. Stirling.
" Removal of a Pharyngeal Tumour," by Mr. Girdlestone.
" Abdominal Hydatids," by Dr. Duncan.
" Porro's Operation," by Dr. Rothwell Adam."
12 Australian Medical Journal. JAN. 15, 1891
" Foreign Bodies in the Eye," by Dt. J. W. Barrett.
" Influenza Epidemic," by Dr. J. P. Ryan.
" Bacilluria of Roberts," by Dr. Ross.
" Chole-cystotomy," by Dr. Balls-Headley.
" Chole-cystotomy," by Dr. C. S. Ryan.
Chole-cystotomy," by Dr. Moore.
" Chloroform Administration," by Dr. J. W. Barrett.
" Rupture of the Eustachian Tube," by Dr. Kenny.
The following papers were read as introductory to a discussion :
" On Removal of the Tongue for Epithelioma," by Dr. Moore.
" On Removal of the Tongue for Epithelioma," by Dr. Duncan.
In addition, the Society (in conjunction with the British Medical Association) assisted Dr. Gresswell to frame a circular to the profession on the subject of the influenza epidemic.
Cases have been exhibited as follows : Excision of Clavicle, by Dr. F. D. Bird.
Excision of Astragalus, by Dr. F. D. Bird.
Excision of Tongue, by Dr. Moore.
Removal of Mastoid, by Dr. J. W. Barrett.
Excision of Hip, by Dr. C. S. Ryan.
Fracture of Patella, by Dr. C. S. Ryan.
Goitre, by Dr. Hooper.
Porro's Operation, by Bothwell Adam.
Gun-shot Wound of Jaw, by Dr. Moore.
Paralysis of Thumb Muscles, by Dr. F. D. Bird.
Pathological Exhibits by Dr. Hooper, Dr. Syme, Dr. Barrett, Dr. Duncan, Dr. Moore, Dr. Woinarski (Ballarat), Dr. Cowan.
Exhibits of Instruments by Dr. Hodgson and Mr. Lewis.
The continuation of the practice of initiating discussions has proved of interest, and its success indicates a line of action to be taken in future. In addition to the meetings at which this business was transacted, and the Annual Meeting, three special meetings were held, at one of which a paper was read by Dr. J. W.
Barrett, on " The Abuse of the Hospital System." At this meeting members expressed themselves freely on the subject of the loose manner in which the hospitals were managed, and a Committee was formed to formulate conclusions. These conclusions were adopted at another special meeting, and made public. It is satisfactory to note that the Charitable Commission has, in its progress report, to some extent endorsed these conclusions. At the second special meeting, the question of Government Medical
JAN. 15, 1891 Annual Report. 13 Fees was discussed. At the third, the question of the prevention of the formation of Special Societies, by forming Special Sections of the Society, was discussed with much vigor. The matter is still sub judice.
Yet again the Committee has to report that the Amending Medical Bill is still existent on paper only. The late Government adopted the Bill drafted by the two Societies, with some modfica- tions (courteously consulting the Societies in connection with it), introduced it, had it read for the first time, and circulated ; then the Government went out, and the Bill took its place with the slaughtered innocents. The completion of Dr. Neild's work of twenty-seven years will be deferred further. However, for the first time, a Government has adopted the principle contended for—
that the public have a right to know the practitioner who has been properly trained from him who has not been so trained.
The matter now before the Society is one of great import, viz., the desirability of amalgamating the Victorian Medical Society and the Victorian Branch of the British Medical Association.
Both Societies have identical objects, the latter being virtually a Victorian Medical Society, which distributes the British Medical Journal.
It meets in the Hall of the older Society, publishes its proceedings in the official organ of the older Society, and most of its members are members of, and its office-bearers officers of, the Victorian Medical Society, and under these circumstances it is felt that force would be conserved, and the prospects of the future of medicine here materially improved, if an amalgamation could be effected. If fused into one extremely powerful Society, the result can but be beneficial to all.
The Committee has met 12 times during the year. The Dr. Balls-Headley 5
Dr. Grant 8
Dr. Girdlestone 8
Dr. Moore 11
Dr. Meyer
Dr. Neild 12
Dr. Syme 6
Dr. J. P. Ryan 10
Dr. C. S. Ryan 3
Dr. Williams
(absent through illness) 1 attendance
has been as follows :—
Dr. Jackson (absent through illness llness durin
g part bof
the year)
Professor Allen(alasent in 8 Europe)
Dr. Hinchcliffe 0
Dr. Le Fevre 0
Dr. Webb 4
Dr. Barrett 7
Dr. Adam 12
Dr. F. D.Bird 4
4
The Committee, in conclusion, trusts that the foregoing report, embodying as it does the record of substantial progress, will be accepted as an evidence of the headway a scientific Society is making in a practical and work-a-day community.
On the motion of Dr. NEILD, seconded by Dr. BRETT, the Committee's Report was adopted.
The LIBRARIAN'S Report was then read by the Secretary.
LIBRARIAN'S REPORT.
I am happy to be able to state that the Library progresses as satisfactorily as it has done for the last eight years. Our set of British Medical Journals is all but completed, and several additions have been made during the last year to the collection of illustrations and plates. I have the honour to acknowledge the following donations :—Royal Medical Chirurgical Society, Photos.
and Transactions ; Clinical Society, Transactions ; Obstetrical Society, Transactions; Baron von Mueller, Journals; Mr. Hayter, Reports. Dr. Daish £1 Is., Dr. Lawrence £1 ls., Dr. Howard
£1, Dr. Kenny £1 ls., Dr. Owen £1 ls., Dr. Hooper £1 Is., Dr. Horne £1 ls., Dr. Laycock ls., Dr. Brett £1, Dr. Snow- ball Cash for Books £2 2s., Sydenham Society £7 Os. 9d.
Dr. NEILD, in a eulogistic manner, proposed the adoption of the Librarian's Report, which was seconded by Dr. LE FEVRE, and carried by acclamation.
Dr. LE FEVRE then read the Treasurer's Report for the past year.
TREASURER'S REPORT.
Mr. PRESIDENT AND GENTLEMEN,—I have the honour to submit for your approval a statement of accounts for the past year, and a balance-sheet showing the position of the Society on December 31st, 1890 :—
The Treasurer in account with the Medical Society of Victoria for the year ending 81st December, 1890.
Dr. I' R. d.
To Balance from 1889 .. 61 18 5
„ Subscriptions and Entrance Fees 322 4 6
£384 2 11
Cr. s. d.
By Interest on Debentures .. • . 4 16 0
„ Insurance.. • • . • 1 0 0
, Repairs to Hall .. • • • . 3 0 0 14 Australian Medical Journal. JAN. 15, 1891
JAN. 15, 1891 Annual Report. 15
By Gas ..
" 3
s.
15 d.
„ Caretaker's Salary and Household Sundries .. 20 4 0 1 Stillwell and Co., for Printing and Postage 222 11 6 Detmold, for Binding, &c. 20 9 7 Periodicals and Freight .. 43 19 0
)9 Furniture ..
• 19 13 0
Petty Cash, per Secretary and Treasurer 7 4 6
,, Stamps in hand .. 0 4 6
Rates .. 5 5 0
Sydenham Society 1 6 0
,, Cheque Book .. 0 8 4
Exchange .. . 0 3 0
Cash overpaid into Bank by Treasurer 0 2 0
,, Balance, Cash in Bank .. 30 1 5
£384 2 11 Audited and found correct,
P. B. BENNIE, Auditor.
BALANCE SHEET, DECEMBER 31ST,
ASSETS.
By Hall and Furniture ..
,, Subscriptions in Arrears Cash in Bank ..
LI To Debentures Outstanding
„ Interest Due ..
„ Balance in favour of Society ..
1890.
s. d.
1000 0 0 207 18 0 30 1 5
£1237 19 5 X s. d.
280 0 0 31 13 0 926 6 5
£1237 19 5 Audited and found correct,
P. B. BENNIE, Auditor.
The present holders of debentures are :- Dr. Balls-Headley
Barker 5 Dr. 0. V. Lawrence •• 5
Mr. Bowen
5 MacGillivray 2
FitzGereld ..
„ Le Fevre ..
„
• • 1
„ •• 10
,, A. S. Gray 5
.. E. M. James
mMer RudiRcal all .. 5 Benevolent
• • 2 nevolent Society .. 12 The Hall and Furniture are set down in the balance sheet at the low valuation of £1000. Though the Society cannot realise been spent in building and furnishing.
With regard to subscriptions in arrears, many members have been accustomed to pay their subscriptions for the previous year at each annual meeting, though, by the rules of the Society, subscrip-
16 Australian Medical Journal. JAN. 15, 1891
tions are due on the first day of the year, in advance. As the Society has now increased its current expenses, in order to supply members with the Australian Medical Journal, it will be necessary in future to collect subscriptions early in each year.
GEO. LE FEVRE, M.D., Treasurer.
Mr. C. S. RYAN proposed, and Dr. ADAM seconded, the adoption of the Report, which was carried unanimously.
ELECTION OF OFFICE-BEARERS.
The following were then elected office-bearers for 1891 : —Presi- dent, Dr. Hinchcliff ; Vice-Presidents, Professor Allen and Mr.
C. S. Ryan ; Hon. Treasurer, Dr. Le Fevre ; Hon. Librarian, Mr.
J. H. Webb; Secretary, Dr. J. W. Barrett; Members of Com- mittee—Drs. Adam, Balls-Headley, F. D. Bird, Girdlestone, Grant, Jamieson, Jackson, Neild, J. P. Ryan, and Williams ; Auditors, Drs. Barker and Bennie.
Dr. JACKSON then introduced the President-elect, and vacated the chair.
Dr. HINCHCLIFF, on taking the chair, said that he very highly esteemed the honor which had been conferred upon him, and though he was not resident in Melbourne, he would endeavour to do his duty to the Society, and, if possible, to do credit to himself and to the Society generally. He then called upon the retiring President (Dr. Jackson) to read his address.
PRESIDENT'S ADDRESS.
GENTLEMEN—On this the completion of my year of office, I am glad to think that the Society, now in the thirty-sixth year of its existence, is in the enjoyment of a sound vitality, and that nothing has occurred during the past twelve months to mar its prosperity or to hinder its progress.
I am pleased to congratulate the Society upon a steady increase in the number of its members, and the absence of any kind of defection. The papers submitted and discussed have been all of them excellent, both in the matter and the manner that have characterised them, and there has always been, on the occasions of our meeting, a dispassionate manner of debate, indicative of genuine scientific earnestness. There has clearly been a con- viction that we come together for mutual benefit and instruction, studiously avoiding display, and foregoing the opportunity for mere argumentation to secure victory.
JAN. 15, 1891 President's Address. 17
Our library, under the enthusiastic management of Dr. Webb, has been, as heretofore, enlarged and improved, so that, now, we possess such a collection of medical works of reference as probably is unequalled on this side of the Equator.
I regret to say, that our hopes of an amendment of the Medical Act have again been dissipated. The late Government took up the question with an apparent determination to carry it through the L
egislature, and, but for the political changes which brought a new Government into existence at the end of the session, we should, I think, at this moment have been enjoying the benefit of an Amended Medical Act, for which very desirable piece of legislation we have been waiting these twenty-six years. It is not to be expected that the present Government will take up the work of medical reform commenced by their predecessors. In common with most Governments, and, unhappily, with the bulk of the community, they are supremely different on the subject of medicine as a profession. Apparently, it is for
every man to use his own judgment, such as it is, in
determining how or by whom he will be treated. Indeed, some legislators, in a
burst of cheap generosity, have declared, not only that an unqualified pretender is as competent to treat disease as an educated practitioner, but that he is probably the superior of this latter. It would almost seem as if your quack were heaven-born, and came into the world with a mission to bless mankind, which mission education would only impair.
Consequently, whenever it has been urged upon the Legislature by the profession that the Medical Act only imperfectly served the end it is theoretically understood to fulfil, the taunt Las generally been ready at hand, that we were only fighting to obtain and to conserve privileges for ourselves, and that with the public weal we had no concern. Even if this latter imputation had any basis of truth, I do not know that we have any less right than those of other callings, whose privileges are secured by law, to.
make sure of the advantages it has cost us so much to obtain.
But, as we of this guild quite well know, the interests of the , public are much more closely involved in the obtainment of an Amended Act than are our own. The public require to be saved from themselves. They have, of course, the abstract right to adopt and to undergo any form of medical treatment they please, but it is only due to them that they should know who those are to whom they resign themselves for treatment ; and it is substan-
is
18 Australian Medical Journal JAN. 15, 1891
tially only thus much that is asked for, namely, that the unqualified charlatan shall be known to be a charlatan, and shall not sail under the stolen colours of those who have undergone the severe educational training which, at this day at least, is imperative to all who desire to pass through the recognised portals of the pro- fession.
We have been engaged, and indeed a good deal exercised, during the year in matters relating to the charitable institutions of the colony. It was necessary that some of the evidence taken by the Charities Commission should be medical evidence, and accordingly this Society was invited to send representatives to furnish such special information as they only could tender. A principal subject of inquiry on these occasions was furnished by the Melbourne Hospital, and the declared necessity for its removal, or its re-building. Almost of necessity, there was a differ- ence of opinion on this question, and I am not sure if the difference was not to be explained, in some measure, on the grounds of personal preference, if not of prejudice. As the original charitable institution of the colony, the Melbourne Hospital necessarily claims prominent consideration, and as it is confessedly the most important metropolitan charity, its condition necessarily has a peculiar interest. It need hardly be said that the leading hospital of Victoria should be as far as possible perfect in its appointments, and that both its arrangements and its organisation should be in accordance with the most recently accepted improvements in hospital requirements. It is nobody's fault that the Melbourne Hospital is not in entire accordance with modern hygienic conditions. It has been built piecemeal, as occasion required, and it is no reflection upon those who, from time to time, constructed it, to say that it does not now fulfil the demands of hospital needs. But it is certain that it has outlived its term of existence, and whether the new Metropolitan Hospital shall be built upon a site removed from the present one, or be rebuilt upon the site where now it stands, may be a question for considera- tion. Remembering the hourly necessities which arise for the immediate reception of cases, both of accident and disease in a large city like this of Melbourne, it is certainly well to inquire how far the inconvenience of distance from the present situation may be balanced by the advantages of improved location. The oft-quoted example of St. Thomas' Hospital, London, may be again referred to. The collective medical science of England
Jex. 15, 1891
President's Address. 19
decided in favour of the institution being rebuilt within the metropolitan area, instead of its being taken away to a suburban neighbourhood, which, if greatly hygienically preferable to its original situation, would render it of subordinate use as a means of prompt relief. No doubt the facility of communication between different and even distant points of the metropolis in this city, should have some weight as an argument in determining the removal of the site, as well as that of the building ; and the contiguity
of the suggested site to the University, has no doubt its reco
mmendation, in that at least one of the purposes of the hospital is to supply the opportunity for study to the students of our Medical School.
In connection with the subject of hospitals, has come up the question of charitable relief generally. With institutions other than those devoted to the treatment of disease and accident, we have, as a profession, no concern, but inasmuch as the larger portion of the charities of the colony are hospitals, and as hospitals cannot exist without medical officers, we are therefore interested in the maintenan ce of that sort of supervision which shall ensure that the recipients of relief deserve what they obtain. I am obliged to confess that there is good reason for believing that at least half of the patients at our hospitals are undeserving of the gratuitous benefits they demand, and that the charities of the colony are, to a large extent, an unnecessary burden upon the common b
enevolence. And in thus specifying the nature of the unmerited claims preferred, I do not include that class of unfor- tunates whose distresses are traceable to improvidence and self indulgence. For the destitute man, however his destitution may have been caused, is an object of commiseration, and as such is entitled to relief. But besides this large class of self-created paupers, there is another class, who, while possessing sufficient means of maintenance, and never denying themselves even the luxuries which abundant wages enable them to obtain, do not scruple to take advantage of charitable relief in whatever way bestowed. And yet, in the face of this obvious practice of imposture, the habit of multiplying
s charitable funds, and so-called benevolent institutio
n goes on. The system is a distinctly pauperising one, and the medical profession are perpetually called upon to aid in supporting it. I am sorry to say that medical men too often lend themselves in the furtherance of such demoralising efforts, and it is because they do so lend themselves that pseudo-
B 2
20 Australian Medical Journal. JAN. 15, 1891 philanthropists persist in extending the work whose effect is only to deaden self-reliance, to discourage self-effort, and, indirectly, to create the belief that thrift and prudence are superfluous qualities.
It must so happen, because possibly well-intentioned, but certainly ill-advised, persons provide means of sustenance and relief, im- posing no conditions in the way of their obtainment.
Not entirely unallied with the system of medical relief, as sup- plied by our charities, is the practice of medical attendance upon members of friendly societies. This question also has been the subject of lively discussion during the past year. It is not to be expected that the club-patient will ever admit that he receives the equivalent of attendance for his contribution to his club-doctor.
He belongs to a class who demand much, and give as little as possible in return. And as there is an eager competition for these offices of club-doctor, it is hardly to be wondered at if the general conclusion outside the profession should be that the advantages of club-practice are on the side of the profession. But the truth is, that the friendly societies are absolute masters of the situation, and they consequently dictate terms which they know must be accepted. It is certain that the profession is overcrowded, especially in the metropolitan district, and to young men com- mencing practice in the widely-extending suburbs of Melbourne, there is virtually no option in the taking of clubs. A beginning has to be made somehow, and the beginning is accordingly made very often under circumstances which involve a renunciation of
self-respect, not only because the remuneration for the services rendered is inadequate, but especially because the relations between medical man and patient are not, as they should be, those of guardian and friend, but of tyrannical master and unwilling, if obsequious, servant. I think few influences have more signally tended to degrade the dignity of medicine than club-practice as it obtains in this part of the world. And there seems to be no remedy for the evil, nor can there well be, so long as the office is contended for by competitors whose condition is that of the apothecary in "Romeo and Juliet," when he consented to supply that impossible poison which acted with such unaccountable rapidity upon the purchaser.
Much has recently been said concerning paying hospitals and private hospitals. There can be no question that many cases, especially surgical cases, cannot properly be treated in private houses. They require special conditions, suitable appliances, and
JAL15, 1891 President's Address. 21
skilled nursing, which in their completeness and sufficiency, can be obtained only in a hospital of some kind. The endeavour has been made to obtain such advantages for the better class of patients, in hospitals originally intended for the reception only of the needy
edy and the destitute. But there are many objections to devoting charitable institutions to this purpose, and, consequently, there have been established several private hospitals, some of which fulfil their purpose very well. It is a matter for con- sideration how far it might be preferable to aggregate such cases in
One large building, rather than to distribute them in smaller structures. It is certain that the very natural and reasonable desire for privacy, rather favours the latter method. At the building, time, there are advantages in a large and well appointed uullding, arranged according to the latest and best hygienic principles, which commend themselves to careful attention.
any case, that would seem to be a judicious provision in the 'abbe Health Act, which contemplates the official inspection of private hospitals. For it is easy to see how establishments of
t
his kind might be ill-directed, and therefore, much abused. For is a no mystery and no secret, inasmuch as recent disclosures have demonstrated it, that some persons in this city receive into quasi-hospitals pregnant women for abortion purposes. The need for the regular inspection of such establishments is, therefore, obvious enough.
In the beginning of the year, the new Public Health Act came into operation, and the Board of Public Health commenced to exercise its functions. Both the statute and the corporate body represented a new departure in public hygiene in this city. The composition of the Board, especially, was an innovation in the nature of an e
xperiment, for, whereas previously this body had con- s
isted of persons selected by reason of their presumed special know- lef
dge of hygiene, the new act provided that it should be composed persons re
presenting and elected from and by the municipal councils of the colony. The chairman, too, was chosen apparently for the reason that he had given no special attention to hygiene, but had been engaged during all his official life in the department of education. As a set-off, however, to this curious disregard of the principle of particular fitness, the Act provided for the engage- ment of a recognised expert in sanitary science, who should not only be the adviser and executive officer of the Board, but who should be a member of it, taking part in its proceedings, and
22 Australian Medical Journal. Jim 15, 1891
sharing in its decisions. And I wish here to say, that in the selection of Dr. Gresswell for this very important office, the Government have been exceptionally fortunate, for not only did that gentleman come to us with the very highest recommendations, but he showed immediately on his arrival that he possessed both the knowledge and the ability necessary to fit him for the duties he had to perform. He has been with us only a twelvemonth, but he has made himself so well-known by the intelligent activity with which his work has been done, that he is already one of the most notable of our public men. And his functions have been exercised with tact, prudence, and a courteous consideration for the feelings of everyone with whom he has been brought in contact. Moreover, he at once identified himself with the profession of which he is so distinguished member, and showed an eager desire to act with us in the important labour he had been commissioned to execute. I dwell especially upon this readiness of Dr. Gresswell to associate himself with the brotherhood of medicine, inasmuch as it has not been the invariable practice of those coming hither from the old country, to do expert work, to recognise in those of the same craft as themselves, confreres and associates. Dr. Gresswell has a stupendous undertaking before him. He has to rescue a new city from the perils of filth-diseases. He has to persuade a people sunk into indifference to nearly all health conditions, that dirt in its larger meaning is the potential factor of untold calamities.
He will have to be an apostle of physical purity, preaching for ever the evangel of that grace which is placed next to godliness.
And in this crusade against misplaced matter, he has the good wishes and the goodwill of all truly good men and women.
The progress of medicine beyond the sea has, for some time past, appeared to centralise in the declared discovery of a cure for phthisis. Dr. Koch's name has been so conspicuously and honour- ably associated with the etiology of tuberculosis, and his claim to the merit of having determined the existence and the operations of the bacillus upon which tuberculous disease depends, that any declaration coming from him was, of necessity, received with atten- tion and respect. When therefore, we were informed that he had de- termined the method of arresting the progress of the patho-genesis due to the presence of this microbe, the attention of the scientific world. here as well as in Europe, was at once arrested. That the public should eagerly accept the assurances conveyed in fragmen-
Ij
JAN. 15, 1891 President's Address. 23 tary telegrams, that consumption was no longer to be ranked among the opprobria nzedicor um, was, if not logical, at any rate not unnatural The belief in specifics has always been a fixed article of the common creed. From the time when Naaman thought that his leprosy ought to be healed by the prophet Elijah striking his hand over the place, there has been a general belief in the magic of specifics. It is, therefore, nothing surprising that the whole world should have been moved by the supposed discovery of a specific for phthisis. But we are yet virtually in the dark as to what the specific is, how it operates, or to what extent it can accomplish all the good that is claimed for it. Its discoverer has given, as yet, but an uncertain sound as to its power in neutra- lising the activity of the causative microbe ; and even supposing that it possesses some of the powers claimed for it, it would appear as if its potency were limited by many conditions. It does not seem to possess, nor is it declared to possess, a prophylactic influence such as we associate with the exhibition of the vaccine virus. Nobody, of course, would venture to charge the discoverer of this tuberculo-bacillicide with insincerity, or disingenuousness in putting forth this project before the world; but it is hardly too much to say that it would have been well if so illustrious a scientist as Dr. Koch had pursued his investigations a little longer in private before speaking so confidently of victories that are yet, as it would seem, unaccomplished. A discovery, which is only in the stage of experiment, cannot justly be reckoned as a scientific truth. It is easy to predict success from imperfectly formulated data, but it is not so easy to make the success clear, however much of hopefulness there may be in the minds both of an inventor and of those who look to be benefited by the inven- tion. The utmost we can say, therefore, with reference to Dr.
Koch's anti-tubercle " lymph " is, that so eminent a pathologist is well entitled to the respectful attention of patient waiting.
I have mentioned, incidentally, the subject of vaccination, and as within the last few days a vessel has entered our chief port, with a crew suffering from small-pox, it is right that I should speak further on a question which has also come before the Public of this colony, quite lately in connection with the arrival from England of a person suffering from the anti- Vaccination craze. This is a mental twist, which shows itself in periodical outbursts in the old country, among a certain class of the community, who discover a passion or an eccentricity, which
24 Australian Medical Journal. JAN. 15, 1891
prompts them to oppose existing institutions of approved utility.
I should offer an affront to this Society if I were to make any reply to the statements of persons so ill-informed in the history of preventive medicine, as to deny the efficacy of vaccination, and to question the blessings which its adoption has conferred upon mankind during the last hundred years. Jenner's discovery was one of those facts which it is a confession of deplorable ignorance to doubt. It has been asked by those in authority, that this Society should meet to consider the objections preferred by a person ignorant of medical science, against the system of enforced vaccination. It might as reasonably be asked of us, that we should assemble to refute Harvey's discovery of the circulation of the blood, or to carry a motion, that Newton was in error on the subject of gravitation.
Reverting back to our own private affairs as a Society, it has been proposed that a fusion should be effected between the Medical Society of Victoria and the Victorian Branch of the British Medical Association. It should not be impossible, and it is probable, that such a union may come about, but the matter, it would seem, can hardly be finally settled without reference on the part of the Branch to the central governing body of the Association. It is certain that there is no real antagonism between the two societies; their objects are identical, they meet under the same roof, and there is practically no difference in their procedure. It has been long thought that the two bodies might become substantially one without any necessary surrender of their several individuality. No doubt some little difficulty presents itself in the way of accomplishing this latter provision, but whether we fuse or we continue in our separate existences, we can harmoniously work towards a common end, our purpose being to benefit the science we practise, and to help each other by an interchange of thought and the record of experience.
In ceasing to occupy the chair of this Society, I have again to thank you for the honour to which you advanced me when you elected me to the office of President. I am deeply sensible of the goodwill which that election evinced, and I trust I may al ways merit the favour you have exhibited towards me, and deserve the respect and confidence of which it is my hope always to be worthy.
The President, Dr. HINCHCLIFF, in proposing a vote of thanks to Dr. Jackson for his address, said he was sure no one would
JAR. 15, 1891 Roll of Members. 25 differ from the remarks so clearly made on the subjects touched upon. He himself was particularly in accord with the views expressed, more especially with regard to the relations of the pro- fession to the public, and especially with reference to lodges.
Dr. J. P. RYAN seconded the proposal, and said that Dr. Jackson had conducted the affairs of the Society in a noble manner. His year would also be noted for the hospitality with which he had treated the members of the Society.
Dr. JACKSON thanked members for the cordial manner in which they had received his address.
The ordinary business being concluded, members were entertained by Dr. Jackson at a social gathering, in the ball of the Society.
ROLL OF MEMBERS.
The following is the roll of members up to December 31, 1890.
Asterisks are placed before the names of those who have been Presidents :—
LIFE MEMBERS.
*Balls-Headley, Walter, M.A., M.D. et C.M. Cantab., M.D. Melb., F.R.C.P. Lond.
Barrett, James William, M.D. et M.S. Melb., F.R.C.S. Eng., Collins Street.
Bird, Frederick Dougan, M.B. et M.S. Melb., M.R.C.S. Eng., Collins Street.
*Bird, Samuel Dougan, M.D. St. A. et Melb., L.R.C.P. Lond., M.R.C.S. Eng, L.S.A. Lond., Collins Street.
*
Bowen, Thomas Aubrey, L.K. et Q.C.P.I., M.R.C.S. Eng., Collins Street.Burke, Stephen John, M.R.C.S. Eng, L.K.Q.C.P.I., Victoria Street, North Melbourne.
*Cutts, William Henry, M.D. Ed. et Melb., L.S.A. Lond., Auburn Road, Hawthorn.
Cutts, William Henry, jun., M.B. et B.S. Mello., Oakleigh.
*
Fetherston, Gerald Henry, M.D. Melb., L.R.C.P.Ed.,L.F.P.S.G., L.A.H.D., High Street, Windsor.*
FitzGerald, Thomas Naghten, F.R.C.S.I., Lonsdale Street.Fletcher, Arthur Augustus, M.D. et B.S. Melb., M.R.C.S. Eng., Lygon Street, Carlton.
*
Haig, William, M.D. Maryland (U.S.), Bank Street, South Melbourne.26 Australian Medical Journal. JAN. 15, 1891
*Hewlett, Thomas, M.R.C.S. Eng., L.S.A. Lond., Nicholson Street, Fitzroy.
*Jackson, James, M.D. Lond. et Melb., M.R.C.S. Eng.
Lawrence, Octavius Vernon, M.D. et Ch. B. Melb., Brunswick Street, Fitzroy.
Maclnerney, James Richard, L. et L. M.K.Q.C.P.I., L.R.C.S.I.
et L.A.H.D., Brunswick Street, Fitzroy.
*Moloney, Patrick, M.B. Melb., Collins Street.
Morton, Francis William Watson, L.R.C.P. et S. Ed., L.M. Ed., Brunswick Street, Fitzroy.
*Neild, James Edward, M.D. et B.S. Melb., L.S.A. Lond., Spring Street.
Penfold, Oliver, M.R.C.S. Eng., L.S.A. Lond., Sandhurst.
Webb, John Holden, M.R.C.S. Eng., L.R.C.P. Lond., Exhibition Street.
ORDINARY MEMBERS.
A'Beckett, William Goldsmid, M.R.C.S. Eng., L.S.A. Lond., Wellington Street, St. Kilda.
Adam, George Rothwell Wilson, M.B. et Ch. M. Ed., Collins Street.
Aitchison, Alexander Smith, M.B. et Ch. B. Melb., Merton Street, Albert Park.
Aitchison, Roderick, M.A. ; M.B. et Ch. B. Melb., Chapel Street, Prah ran.
Allen, Harry Brookes, M.D. et B.S. Melb., Melbourne University.
Alsop, Thomas Osmond Fabian, M.B. et Ch. M. et L.M.
M.R.C.S. Eng., Bur wood Road, Hawthorn.
Anderson, Alfred Victor Millard, M.B. et B.S. Melb., Alfred Hospital.
Anderson, Eugene Wilton, M.D. Melb., L. et L.M.R.C.S. et L.R.C.P. Edin., Burwood Road, Hawthorn.
Anderson, James, L. et L.M.R.C.P. et S. Ed., L.F.P.S.G., Footscray.
Anderson, T. C., M.A. ; M.B., C.M. Aberd., Footscray.
Annand, George, M.D. et B.S. Melb., M.R.C.S. Eng., L. et L.M.R.C.P. et S. Ed., High Street, St. Kilda.
Armstrong, William, M.D. et B.S. Melb., Brunswick Street, Fitzroy.
Astles, Harvey Eustace, M.D. St. A., F.R.C.P. Ed., Collins Street.
Backhouse, John Burder, M.B. et B.S. Melb., Bay Street, Brighton.
